Provider Demographics
NPI:1649758392
Name:HERING, GWEN (LPC)
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:
Last Name:HERING
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N6975 NEUPERT RD
Mailing Address - Street 2:
Mailing Address - City:LAKE MILLS
Mailing Address - State:WI
Mailing Address - Zip Code:53551-9623
Mailing Address - Country:US
Mailing Address - Phone:920-988-0505
Mailing Address - Fax:
Practice Address - Street 1:1173 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-1672
Practice Address - Country:US
Practice Address - Phone:920-988-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3866-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional